| NPI | 1568478675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT22751) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT011602) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-01-23 |