| NPI | 1023615002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213819) |
| 225100000X Physical Therapist (Licence: DC CP030290T) | |
| Enumeration Date | 2020-10-03 |
| Last Update Date | 2024-03-29 |