| NPI | 1215986013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT010068) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017243) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2007-07-08 |