| NPI | 1750775557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0134119) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: PA 024271) | |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2020-01-02 |