| NPI | 1194058396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT008697) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010475) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2025-08-16 |