| NPI | 1326357930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT005686) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT013083) |
| 225100000X Physical Therapist (Licence: WV PT002931) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2016-05-05 |