| NPI | 1285789784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT4780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT20016) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-08 |