| NPI | 1710656988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT020120) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 17781) |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2022-12-23 |