| NPI | 1205138278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 230520638) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033284) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2012-10-18 |