| NPI | 1780819201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WV 002272) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: WV 002272) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2018-03-17 |