| NPI | 1770216590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT2608) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251G0304X Physical Therapist, Geriatrics (Licence: DC PT2608) | |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-07-08 |