| NPI | 1851951073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27534) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT5000015) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2021-11-09 |