| NPI | 1619391083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 10205) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 15148) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-02-05 |