| NPI | 1548693484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208243) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: VA 2305208243) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305208243) | |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2019-01-01 |