| NPI | 1629156377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9148) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT-010675) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-11-10 |