| NPI | 1639375090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 6435) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-004086-E) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2021-09-23 |