NPI | 1295817658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305006730) |
Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: VA 2305006730) |
Enumeration Date | 2006-10-19 |
Last Update Date | 2007-07-08 |