| NPI | 1588004188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT014357) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003168) |
| 225100000X Physical Therapist (Licence: KY PT006231) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2016-04-25 |