| NPI | 1215247713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206692) |
| 225100000X Physical Therapist (Licence: DC PT871203) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2020-08-07 |