| NPI | 1376298968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 305952) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT019662) |
| Enumeration Date | 2022-02-13 |
| Last Update Date | 2024-09-04 |