| NPI | 1326317207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT10010) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006017) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2013-04-17 |