| NPI | 1891522041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002504) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30045) |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2024-10-09 |