| NPI | 1508335001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212942) |
| 225100000X Physical Therapist (Licence: NC P18696) | |
| 225100000X Physical Therapist (Licence: IN 05013223A) | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2019-11-25 |