| NPI | 1437892486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 002291) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204523) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2022-04-18 |