| NPI | 1770928475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT006041) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT002309) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2013-05-08 |