| NPI | 1194892331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305203449) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC DC871116) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2014-11-02 |