| NPI | 1134858699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019669) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: OH PT019669) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-07-03 |