| NPI | 1104337690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003825) |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2017-10-24 |