| NPI | 1609284371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305202720) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: VA 2305202720) |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2014-07-25 |