| NPI | 1598956260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT 7643) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: OH LPO 218) |
| 224P00000X Prosthetist (Licence: OH LPO 218) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2007-08-07 |