| NPI | 1104092881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT7994) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT1979) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2011-07-08 |