| NPI | 1124370127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206652) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003080) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2024-08-28 |