| NPI | 1548570658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305207266) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: DC PT871546) |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2017-04-27 |