| NPI | 1881914752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT. 012732) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1195670) |
| 225100000X Physical Therapist (Licence: MD 23098) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2010-06-02 |