| NPI | 1598955866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT 010751) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WV 2346) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2012-01-30 |