| NPI | 1326613670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008260) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT019282) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2021-06-03 |