| NPI | 1649209040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT010060) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT015647) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2025-04-04 |