| NPI | 1023220209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204674) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2305204674) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2011-02-24 |