| NPI | 1346975240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT002767) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212461) |
| Enumeration Date | 2022-07-24 |
| Last Update Date | 2025-10-09 |