| NPI | 1487004701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 006861) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT016404) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2018-06-08 |