| NPI | 1558610790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT016616) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003052) |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2017-01-11 |