| NPI | 1619328804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871909) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD PT22016) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2016-06-29 |