| NPI | 1427740844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD CP044246T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020530) |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2025-05-16 |