| NPI | 1619030178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT007991) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 07991) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-01-10 |