| NPI | 1255796603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT 002507) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT012739) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2015-12-29 |