| NPI | 1508189135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23102) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 012679) |
| 225100000X Physical Therapist (Licence: NY 030342) | |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2022-06-10 |