| NPI | 1235495854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 002568) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24008) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2013-07-03 |