| NPI | 1316327828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871767) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25513) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2023-01-25 |