| NPI | 1700568854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 009006) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020669) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2025-04-18 |