| NPI | 1568077386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 25398) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018928) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2021-02-10 |