| NPI | 1972705804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT 013396) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 2829) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2011-10-13 |