| NPI | 1164175857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28853) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH CP027333T) |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2025-10-31 |