| NPI | 1043505209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206914) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3731) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2012-09-10 |