| NPI | 1124039243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 002017) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT013202L) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |