| NPI | 1831449289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16449) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT210002185) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2023-10-03 |