| NPI | 1396796876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT013903L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT008837) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-07-08 |