| NPI | 1174089916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: OH PT017879) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2022-04-19 |