| NPI | 1356956510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048828) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018934) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2023-12-07 |