| NPI | 1689240244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 009166) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT019344) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2024-10-17 |