| NPI | 1245003706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH CP025952T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05014807A) |
| 225100000X Physical Therapist (Licence: VA CP032188T) | |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2024-06-24 |