| NPI | 1780278382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872737) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2021-03-24 |