| NPI | 1710445895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT018425) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3917) |
| 225100000X Physical Therapist (Licence: ND 2242) | |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2020-12-10 |