| NPI | 1851726038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213367) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 8658269-2401) |
| 225100000X Physical Therapist (Licence: ID PT3355) | |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2019-12-27 |