| NPI | 1023339991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7824) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT 002841) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2017-06-08 |