| NPI | 1255492278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT015333) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT002325) |
| 225100000X Physical Therapist (Licence: OH PT009810) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |