| NPI | 1780668566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22462) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204474) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2013-08-29 |