| NPI | 1629403589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT014676) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH6942) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2023-09-19 |