| NPI | 1700510104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215499) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: DC PT210002325) | |
| 225100000X Physical Therapist (Licence: MD CP032151T) | |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2024-11-18 |