| NPI | 1003665910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC CP031384T) |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2024-05-14 |