| NPI | 1588669394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT06009) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KY PT002212) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2014-01-24 |