| NPI | 1295265742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17885) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT016982) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2018-11-21 |