| NPI | 1659153997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP050073T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020777) |
| Enumeration Date | 2023-10-20 |
| Last Update Date | 2025-11-24 |