| NPI | 1740284603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT 09980) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KY 005788) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2011-03-29 |