| NPI | 1083816763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT.001784) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.001784) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2007-07-18 |