| NPI | 1366780256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT. 014052) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 014052) |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2025-10-01 |