| NPI | 1508450800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4472) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT016571) |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-11-16 |