| NPI | 1568717007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022042) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2013-08-29 |