| NPI | 1003462250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: WV 002422) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2019-08-14 |