| NPI | 1780084475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017348) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208962) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2018-04-26 |