| NPI | 1962468637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 10600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT08833) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-08 |