| NPI | 1073896866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207093) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 19086) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2011-09-28 |