| NPI | 1699311530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR PT64543) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018397) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2022-09-08 |