| NPI | 1427407915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25986) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003633) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2021-11-16 |