| NPI | 1497794614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT-011470) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT-011470) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2014-01-20 |