| NPI | 1487816534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT 2701) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 005341) |
| 225100000X Physical Therapist (Licence: OH PT012319) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2009-04-15 |