| NPI | 1083283428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019149) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MD 28502) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-04-28 |