| NPI | 1376727107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT002675) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019086) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2007-12-28 |