| NPI | 1699711598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT870468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 19226) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2016-03-03 |