| NPI | 1174617088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 002305) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016500) |
| 225100000X Physical Therapist (Licence: OH PT010424) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2018-07-09 |