| NPI | 1467527101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT23549) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 5225) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2011-07-07 |