| NPI | 1336113497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT011347) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT 5940) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2015-09-08 |