| NPI | 1194244913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012701A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT016840) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2018-03-17 |