| NPI | 1366125106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215883) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC CP035051T) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2026-02-26 |