| NPI | 1730485376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206758) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 004477) |
| Enumeration Date | 2011-01-30 |
| Last Update Date | 2024-12-07 |