| NPI | 1124555651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 6323) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 6323) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2025-09-11 |