| NPI | 1225454226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 014488) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2019-10-01 |