| NPI | 1275771776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305205598) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870957) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2012-09-18 |