| NPI | 1497707228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA pt006762L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT010934) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2017-12-07 |