| NPI | 1184124372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214117) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 003899) |
| 225100000X Physical Therapist (Licence: DE J1-0003876) | |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2021-01-20 |