| NPI | 1255833737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH CP008679T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007334) |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2023-01-24 |