| NPI | 1023983186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC CP051315T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30702) |
| Enumeration Date | 2025-10-08 |
| Last Update Date | 2025-12-03 |