| NPI | 1598446585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002484) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29544) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2026-09-02 |