| 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 |