| NPI | 1538649611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 18428) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 09587) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2023-09-29 |