| NPI | 1134577737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28558) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872197) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2024-01-12 |