| NPI | 1295996734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT 002697) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027723) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2022-05-10 |