| NPI | 1568473585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 001071) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT007090) |
| 225100000X Physical Therapist (Licence: PA PT006827L) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2024-04-01 |