| NPI | 1720119688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 004923) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 009831) |
| 225100000X Physical Therapist (Licence: IN 05009455A) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2015-05-12 |