| NPI | 1184889586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: OH PT012761) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: IL 070016476) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2022-01-04 |