| NPI | 1205287018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT006982) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 1896) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2024-04-24 |