| NPI | 1821328568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10823) |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2009-12-31 |