| NPI | 1477110328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017890) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014331) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2023-02-21 |