| NPI | 1568536639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT001848) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH AT000175) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2011-10-26 |