| NPI | 1295370070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT872625) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27701) |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2024-03-20 |