| NPI | 1225659097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT020874) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.024668) |
| Enumeration Date | 2020-05-02 |
| Last Update Date | 2026-03-20 |