| NPI | 1700412137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007937) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030070) |
| 225100000X Physical Therapist (Licence: OH PT016819) | |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2023-02-06 |