| NPI | 1710011671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT-004636) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT4636) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2017-04-10 |