| NPI | 1063057636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1325246) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018087) |
| 225100000X Physical Therapist (Licence: SC 9733) | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2019-11-07 |