| NPI | 1073960191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT003616) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 003616) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2023-08-28 |