| NPI | 1861776551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207374) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 026932) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2016-10-02 |