| NPI | 1437161239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 001333) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT006713) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2016-05-27 |