| NPI | 1629769575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1288462) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT016740) |
| Enumeration Date | 2023-05-19 |
| Last Update Date | 2023-05-19 |