| NPI | 1659858983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP030484T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT200001365) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2024-04-04 |