| NPI | 1073570800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305005347) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 870572) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2010-11-29 |