| NPI | 1275701450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.156622) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501010890) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2026-06-25 |