| NPI | 1851831945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872378) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2023-10-03 |