| NPI | 1639456569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT002637) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT007099) |
| Enumeration Date | 2011-11-06 |
| Last Update Date | 2011-11-06 |