| NPI | 1245809573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30366) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT210002489) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-08-03 |