| NPI | 1598721599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 2145) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT007427) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2012-02-02 |