| NPI | 1003696659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT016160) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV CP026348T) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2023-12-11 |