| NPI | 1720529480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT016516) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006933) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |