| NPI | 1437615689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT004202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027462) |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2020-07-06 |