| NPI | 1437537784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT015274) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006601) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2023-07-20 |