| NPI | 1104604115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002379) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: DC PT210002379) |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2023-09-20 |