| NPI | 1417550013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018988) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2024-06-24 |