| NPI | 1659771855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209031) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2019-02-13 |