| NPI | 1992163737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211681) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872220) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2019-01-09 |