| NPI | 1942572904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 13515) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2014-02-18 |