| NPI | 1720740533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT200001318) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28702) |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2022-10-13 |