| NPI | 1306318647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT003716) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212262) |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2022-12-06 |