| NPI | 1942554548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871440) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207710) |
| Enumeration Date | 2012-11-04 |
| Last Update Date | 2015-06-02 |