| NPI | 1023573987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT015485) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 004057) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2023-11-10 |