| NPI | 1386679454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT.009000) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 004065) |
| 225100000X Physical Therapist (Licence: IN 05008966A) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-08-31 |