| NPI | 1982157202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26091) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872086) |
| 225100000X Physical Therapist (Licence: VA 2305210863) | |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2018-12-26 |