| NPI | 1356430151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH6941) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT004642) |
| 225100000X Physical Therapist (Licence: OH PT011660) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-01-14 |