| NPI | 1255418562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 000269) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 00269) |
| 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305001499) | |
| 225100000X Physical Therapist (Licence: VA 2305001499) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-07-21 |