| NPI | 1225562754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34732) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8502) |
| 225100000X Physical Therapist (Licence: OH PT016327) | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2021-12-14 |