| NPI | 1467764670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT003198) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 230520576) |
| 225100000X Physical Therapist (Licence: KY PT005628) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2019-07-16 |