| NPI | 1235839754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05013742A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018679) |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2023-03-03 |