| NPI | 1982990255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT013397) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT005825) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2011-08-23 |