| NPI | 1457936643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT004581) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36869) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2022-12-05 |