| NPI | 1891454856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002256) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: VA 2305215570) | |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2023-12-26 |