| NPI | 1750499885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305002825) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305002825) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2008-08-12 |