| NPI | 1609274117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207513) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 0000009556) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2014-12-16 |