| NPI | 1427137249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 006342) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT003689) |
| 225100000X Physical Therapist (Licence: OH PT10441) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2009-11-02 |