| NPI | 1073056867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT016434) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05012096A) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2019-02-20 |