| NPI | 1477537835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT014331) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009606) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2025-03-21 |