| NPI | 1346548484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017205) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1198228) |
| Enumeration Date | 2011-03-13 |
| Last Update Date | 2021-06-01 |