| NPI | 1114332129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019652) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2022-02-18 |