| NPI | 1215802533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT022061) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX CP050202T) |
| Enumeration Date | 2025-10-07 |
| Last Update Date | 2025-10-08 |