| NPI | 1609297688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT 012482) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT012482) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2022-03-15 |