| NPI | 1558337758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204810) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 9856) |
| 225100000X Physical Therapist (Licence: DC PT871772) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2024-01-26 |