| NPI | 1184741431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305006677) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 3599) |
| 225100000X Physical Therapist (Licence: NC 5931) | |
| 225100000X Physical Therapist (Licence: KY 003679) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |