| NPI | 1083634422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 011312) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 2516) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2014-08-07 |