| NPI | 1619386927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT017843) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21254) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2019-01-15 |