| NPI | 1447567714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207858) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031434-1) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2019-09-03 |