| NPI | 1861759664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002152) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24899) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2024-02-22 |