| NPI | 1285659037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204537) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870899) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2010-05-03 |