| NPI | 1023697026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT190701) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC PT.12372PT) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2024-06-17 |