| NPI | 1275183592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT200001320) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214012) |
| 225100000X Physical Therapist (Licence: OH PT018195) | |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2022-10-21 |