| NPI | 1770733495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22385) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870998) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2022-07-20 |