| NPI | 1972829935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206677) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: FL PT26651) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2012-10-03 |