| NPI | 1346735123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 003986) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P18077) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2020-09-29 |