| NPI | 1669422515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 002490) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 011100) |
| 225100000X Physical Therapist (Licence: KY 004756) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2014-01-10 |