| NPI | 1972938561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV PT3039) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003189) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2024-05-06 |