| NPI | 1841620630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208424) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 15872) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2018-07-12 |