| NPI | 1396726907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305005843) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026017) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2015-12-02 |