| NPI | 1780977090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871157) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23195) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2011-05-19 |