| NPI | 1184997074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 013568) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.023867) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2018-03-14 |