| NPI | 1740697903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT 003204) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011505) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2016-05-26 |