| NPI | 1326457490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27149) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208925) |
| 225100000X Physical Therapist (Licence: DC PT872316) | |
| Enumeration Date | 2014-08-03 |
| Last Update Date | 2024-10-29 |