| NPI | 1669252060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305215579) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: DC PT210002330) |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2023-10-03 |