| NPI | 1013126820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 20726) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 870383) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2019-12-18 |