| NPI | 1518439470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211630) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63063) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2018-12-17 |