| NPI | 1689006314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60286) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 012143) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-08-05 |