| NPI | 1699427732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28808) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT004467) |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2022-01-20 |