| NPI | 1396631164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 1719624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT022447) |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2026-05-20 |