| NPI | 1447213590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305001965) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: VI 2305001965) |
| 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305001965) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2007-07-08 |