| NPI | 1851774442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209583) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019007635) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2015-07-09 |