| NPI | 1124861380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT021167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR CP032012T) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-06-17 |