| NPI | 1912287509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021485) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT014148) |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2017-04-24 |