| NPI | 1104034032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305203014) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 9669) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |