| NPI | 1669032884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP034998T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018019) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2024-09-30 |