| NPI | 1255164786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY CP033412T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT021310) |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2024-08-21 |