| NPI | 1144986381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031129) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018459) |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2023-06-05 |