| NPI | 1194810945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305205942) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 23069) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2009-06-03 |