| NPI | 1083931000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT002789) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: WV PT002789) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WV PT002789) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2010-08-18 |