| NPI | 1538708755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 018124) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018124) |
| 261QP2000X Clinic/Center Physical Therapy (Licence: CA 297919) | |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2020-10-09 |