| NPI | 1336335439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT.35311) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.007563) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2022-01-05 |