| NPI | 1396215893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21119) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872323) |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2024-01-31 |