| NPI | 1568133155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214361) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC CP033595T) |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2024-09-04 |