| NPI | 1265764534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1144111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002484) |
| 225100000X Physical Therapist (Licence: PA PT019993) | |
| 225100000X Physical Therapist (Licence: NY 021895) | |
| 225100000X Physical Therapist (Licence: VA 2305205380) | |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2010-02-11 |