| NPI | 1558542134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT017411) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT 002486) |
| Enumeration Date | 2007-11-24 |
| Last Update Date | 2007-11-24 |