| NPI | 1659725554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: VA 2305209971) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: MD 21155) |
| Enumeration Date | 2016-04-17 |
| Last Update Date | 2016-12-01 |