| NPI | 1609975440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PT-008779) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT8779) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2014-11-12 |