| NPI | 1689074056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25105) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT200001319) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2024-09-18 |