| NPI | 1184263550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT297970) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018413) |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2020-02-08 |