| NPI | 1861714305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22607) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT871010) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2010-02-25 |