| NPI | 1407403868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018219) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2023-05-25 |