| NPI | 1831394907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT 012992L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT 008879) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2018-11-16 |