| NPI | 1770030470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210681) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040375) |
| Enumeration Date | 2016-09-09 |
| Last Update Date | 2016-09-09 |