| NPI | 1417101817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 019376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01126500) |
| 225100000X Physical Therapist (Licence: VA 2305205667) | |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2008-11-11 |