| NPI | 1235107806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 10278) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT-005281) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2009-11-24 |