| NPI | 1568988350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26608) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872152) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2021-07-29 |