| NPI | 1659564649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 10626) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 2204) |
| 225100000X Physical Therapist (Licence: WA 9985) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |