| NPI | 1164007365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC 872748) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28309) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2023-12-28 |