| NPI | 1033548763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 012818) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: OH 012818) |
| 2251X0800X Physical Therapist Orthopedic (Licence: OH 012818) | |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2016-08-15 |