| NPI | 1982114534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211411) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003808) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2017-10-10 |