| NPI | 1194836403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT019593) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 011556) |
| 225100000X Physical Therapist (Licence: OH PT 011556) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2017-04-12 |