| NPI | 1518319474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210253) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040261) |
| Enumeration Date | 2016-07-04 |
| Last Update Date | 2018-05-03 |