| NPI | 1154413276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 7772) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204477) |
| 225100000X Physical Therapist (Licence: PA PT018410) | |
| 225100000X Physical Therapist (Licence: MD 22079) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2008-12-10 |