| NPI | 1942869821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872443) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2020-11-25 |