| NPI | 1518516830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1208755) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT017025) |
| 225100000X Physical Therapist (Licence: NM PT-2024-0093) | |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2024-04-27 |