| NPI | 1083500938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 009337) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH CP046726T) |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-12-11 |