| NPI | 1285980284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 003062) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26978) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2022-02-17 |