| NPI | 1598210098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT.004072) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT001786E) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2016-08-25 |