| NPI | 1396707477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305205754) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017462) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2014-08-08 |