| NPI | 1679257034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: OH PT020611) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020611) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2025-04-10 |