| NPI | 1790864627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ PT-8043) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT 008551) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2017-02-17 |