| NPI | 1902344203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT-006930) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT016567) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |