| NPI | 1356965214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019583) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213536) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2022-12-05 |