| NPI | 1548636129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214035) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28427) |
| 225100000X Physical Therapist (Licence: DC PT5000013) | |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2026-07-17 |