| NPI | 1710623483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002491) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216702) |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2024-09-20 |