| NPI | 1396518874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT021317) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 008959) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2024-08-19 |