| NPI | 1164494977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305202617) |
| Additional Taxonomies | 171WH0202X Contractor Home Modifications |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2008-12-11 |