| NPI | 1972507515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT200001255) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 20977) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2022-06-28 |