| NPI | 1235973082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT021233) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: OH PT021233) |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2026-01-23 |