| NPI | 1700160603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 32548) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 012800) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2022-07-21 |