| NPI | 1952916579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 101317) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT004336) |
| 225100000X Physical Therapist (Licence: VA CP003975T) | |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2024-03-20 |