| NPI | 1144523101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305005400) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 4747) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2012-04-04 |