| NPI | 1619949286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305006535) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305006535) |
| 2251S0007X Physical Therapist Sports (Licence: VA 2305006535) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2018-03-14 |