| NPI | 1669522488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT2000017) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MD 19982) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2024-10-08 |