| NPI | 1336772219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT018942) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027957) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2021-03-19 |