| NPI | 1154825628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017294) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 297754) |
| 225100000X Physical Therapist (Licence: TX 1302591) | |
| 225100000X Physical Therapist (Licence: IA 091389) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-03-28 |