| NPI | 1992598585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002572) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2025-05-27 |
| Last Update Date | 2025-07-18 |