| NPI | 1457431975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11380) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT-007414) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2013-10-22 |