| NPI | 1013203330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT871375) |
| 225100000X Physical Therapist (Licence: VA 2305206940) | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2021-04-23 |