| NPI | 1487879359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OH 9451) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WA 8829) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2010-01-20 |