| NPI | 1629692603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV CP015925T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018715) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2022-12-06 |