| NPI | 1922311851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT014355) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: FL 25667) |
| 2251X0800X Physical Therapist Orthopedic (Licence: OH 014355) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2017-05-02 |