| NPI | 1881902336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 009658) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 002753) |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2010-09-17 |