| NPI | 1700221314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871432) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206837) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2013-05-08 |