| NPI | 1619129806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT017349) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT2532) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2021-03-05 |