| NPI | 1528509593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32392) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT016742) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2017-03-10 |