| NPI | 1639629884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1278077) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2019-11-13 |