| NPI | 1457737363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003510) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2020-05-22 |