| NPI | 1700260429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT.015495) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2020-03-11 |