| NPI | 1083675763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 31733) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 002576) |
| 225100000X Physical Therapist (Licence: KY 004749) | |
| 225100000X Physical Therapist (Licence: OH 011539) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-07-22 |