| NPI | 1215016696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 11601) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 2535) |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2007-07-08 |