| NPI | 1326258385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 19812) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 870275) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2025-01-03 |