| NPI | 1528480019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0013173) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 014451) |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2023-03-21 |