| NPI | 1306617113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 6046) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH CP035006T) |
| 225100000X Physical Therapist (Licence: IA CP032042T) | |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2024-10-24 |