| NPI | 1710726393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 004771) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH CP035178T) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2024-09-26 |