| NPI | 1679807341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 012633) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 003540) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2019-01-17 |