| NPI | 1497074702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OH 015162) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 12646) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2015-06-09 |