| NPI | 1639414907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 015504) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20316) |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2021-04-16 |