| NPI | 1407215528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017332) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22202) |
| 225100000X Physical Therapist (Licence: CA 292009) | |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2018-04-30 |