| NPI | 1386600773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT012071) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT013456L) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2014-09-10 |