| NPI | 1497303374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213485) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR AR4692) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2020-06-10 |