| NPI | 1043540586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08178R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT012728) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2022-02-14 |