| NPI | 1689557043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH CP048599T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05014461A) |
| Enumeration Date | 2025-07-30 |
| Last Update Date | 2025-08-27 |