| NPI | 1801134580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305202408) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 28860) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2019-01-04 |