| NPI | 1962816314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19494) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013303) |
| 225100000X Physical Therapist (Licence: WV PT 003309) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2021-09-20 |