| NPI | 1700300878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist Geriatrics (Licence: OH PT017037) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: VA 2305210529) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2017-08-01 |