| NPI | 1609982297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 9748) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204687) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2014-11-22 |