| NPI | 1134292576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214128) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870715) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-09-06 |