| NPI | 1447649173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT.014845) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: OH PT.014845) |
| Enumeration Date | 2015-01-19 |
| Last Update Date | 2024-02-16 |