| NPI | 1871867853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005954) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT 003039) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2017-01-25 |