| NPI | 1073986402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 003876) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2024-04-01 |