| NPI | 1154770675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014448) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003629) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2021-11-29 |