| NPI | 1487063236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 9911) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208913) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2016-04-08 |