| NPI | 1417033424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 2256) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 25452) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2010-05-18 |