| NPI | 1942289400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305205436) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10174) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2018-03-17 |