| NPI | 1467880930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 014410) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0013245) |
| 225100000X Physical Therapist (Licence: KY 007316) | |
| Enumeration Date | 2013-10-21 |
| Last Update Date | 2019-09-17 |