| NPI | 1417541228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT020531) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-31372) |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2023-05-24 |