| NPI | 1306639208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT033126) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020974) |
| Enumeration Date | 2025-05-23 |
| Last Update Date | 2025-05-23 |