| NPI | 1952855207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26094) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210518) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-04 |