| NPI | 1669881850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 003374) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1865) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2014-08-13 |