| NPI | 1245533066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 033274) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206773) |
| 225100000X Physical Therapist (Licence: MD 23517) | |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2010-12-16 |