| NPI | 1831414689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5972) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT .012590) |
| 225100000X Physical Therapist (Licence: AZ 8823) | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2010-04-05 |