| NPI | 1386747202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305202184) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 0105202184) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2011-04-21 |