| NPI | 1356505432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 002696) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT 012939) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2016-05-27 |