| NPI | 1982668232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305202092) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26834) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2019-02-12 |