| NPI | 1356310304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: KY 4066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT-009584) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2017-02-07 |