| NPI | 1497981161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206387) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 11681) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2011-01-16 |