| NPI | 1568471969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT-003600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT008488L) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2016-03-18 |