| NPI | 1801847256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05008182A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 7560) |
| 225100000X Physical Therapist (Licence: MT 1629) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-07-08 |