| NPI | 1386751253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 18685) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204436) |
| 225100000X Physical Therapist (Licence: FL PT22353) | |
| 225100000X Physical Therapist (Licence: DC PT870101) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2009-10-08 |