| NPI | 1376509562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT006869) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH PT-006869) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-07-08 |