| NPI | 1063789931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005952) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.013553) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2015-05-12 |