| NPI | 1891740478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P11167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305202681) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2020-11-10 |