| NPI | 1417186032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT020202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006560) |
| 225100000X Physical Therapist (Licence: MI 5501018699) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2023-01-18 |