| NPI | 1609153113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207226) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034451) |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2012-01-13 |