| NPI | 1235764358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 017570) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9658) |
| 225100000X Physical Therapist (Licence: KY 007928) | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2024-05-19 |