| NPI | 1366205858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH CP048600T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT032007) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-08-12 |