| NPI | 1306030366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT.010842) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 2352) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2014-02-18 |