| NPI | 1689106197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT016738) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025935) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-04-03 |