| NPI | 1023002268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8839) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 001945) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2018-04-15 |