| NPI | 1104920834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT-2690) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT-000737) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2007-07-08 |