| NPI | 1124311709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: student) |
| 225100000X Physical Therapist (Licence: OH PT019702) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2025-08-19 |