| NPI | 1548406218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 029778) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870973) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2010-12-09 |