| NPI | 1760808075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208564) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9915) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2014-03-18 |