| NPI | 1144609264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT1602) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT7749) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2015-05-21 |