| NPI | 1447675129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT-014669) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT-006393) |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2016-11-16 |