| NPI | 1326428186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209713) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003820) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-11-29 |