| NPI | 1104458934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19395) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2022-04-26 |