| NPI | 1548848054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT200001370) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028836) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2022-06-13 |