| NPI | 1316513526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: KY 008255) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT019230) |
| Enumeration Date | 2021-05-28 |
| Last Update Date | 2021-05-28 |