| NPI | 1447716980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11102) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: OH PT016629) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: KY 007331) | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2024-01-03 |