| NPI | 1518396969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44564) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.014365) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2026-05-04 |