| NPI | 1235340597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305005939) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT2749) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2008-05-22 |