| NPI | 1871865493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1213886) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 013539) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2017-03-01 |