| NPI | 1538413158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P16725) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003087) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2017-02-03 |