| NPI | 1528494804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.013106) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2015-07-15 |