| NPI | 1194217323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: OH 017390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 017390) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: OH 017390) | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2025-03-24 |