| NPI | 1598951493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204220) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: B1362743) |
| 225100000X Physical Therapist (Licence: MD 18054) | |
| 225100000X Physical Therapist (Licence: SC 2572) | |
| 225100000X Physical Therapist (Licence: TN 0000004337) | |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2007-09-25 |