| NPI | 1215282306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT015026) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022093) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2014-08-21 |