| NPI | 1114079506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: OH PT010594) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: PA PT009160L) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-08 |