| NPI | 1326703653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP007886T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT004329) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2021-11-02 |