| NPI | 1629347596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT871747) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2024-02-19 |