| NPI | 1306107164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207396) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 871853) |
| 225100000X Physical Therapist (Licence: MD 26663) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2023-07-27 |