| NPI | 1922340736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61628) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT014151) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2016-08-22 |