| NPI | 1962828889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT31962) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 014472) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2017-01-25 |