| NPI | 1013226125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 013999) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004632) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2012-11-14 |