| NPI | 1528437001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209098) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25151) |
| 225100000X Physical Therapist (Licence: WV PT 003425) | |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2020-01-23 |