| NPI | 1386998029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2013005479) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 014049) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2013-05-08 |