| NPI | 1265849483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9041) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006430) |
| 225100000X Physical Therapist (Licence: OH 014731) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NC P16648) | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2019-01-04 |