| NPI | 1497142731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12060) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.014786) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2018-10-04 |