| NPI | 1134318009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28047) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT013580) |
| 225100000X Physical Therapist (Licence: WV 002667) | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2026-08-20 |