| NPI | 1902652456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT004926) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216394) |
| Enumeration Date | 2024-04-25 |
| Last Update Date | 2025-12-31 |