| NPI | 1447337969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT016038) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA 05972) |
| 225100000X Physical Therapist (Licence: WV 003396) | |
| 225200000X Physical Therapy Assistant (Licence: KY PTA A01986) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-07-13 |