| NPI | 1144686999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD MD25774) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT871911) |
| Enumeration Date | 2016-01-10 |
| Last Update Date | 2024-04-29 |