| NPI | 1053389114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT.011095) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KY PT.004781) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2010-03-01 |