| NPI | 1285268649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: DC PT872610) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213430) |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2024-03-04 |