| NPI | 1790881704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305005169) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104000724) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2014-07-04 |