| NPI | 1790167195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT-015377) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT- 006619) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2016-06-30 |