| NPI | 1114678232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002176) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28823) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2023-09-16 |