| NPI | 1245269877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT.011978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016955) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2008-10-20 |