| NPI | 1922192541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002172) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT010972) |
| 225100000X Physical Therapist (Licence: NC 12463) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2012-04-26 |