| NPI | 1174526800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 001435) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 001435) |
| 225100000X Physical Therapist (Licence: SC 5731) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2024-11-20 |