| NPI | 1134887979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215008) |
| 225100000X Physical Therapist (Licence: DC PT210002133) | |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2024-08-22 |