| NPI | 1760850481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871863) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209774) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2024-05-20 |