NPI | 1194500595 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002404) |
Additional Taxonomies | 225100000X Physical Therapist |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2023-08-25 |
Last Update Date | 2024-01-24 |