| NPI | 1003430380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0017799) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 018604) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2021-10-25 |