| NPI | 1518393099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305003777) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 003444) |
| 225100000X Physical Therapist (Licence: NY 036867) | |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2018-01-31 |