| NPI | 1336330893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: OH PT-9535) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: OH AT-865) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2010-12-23 |