| NPI | 1710954243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT012116) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017787) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2023-05-11 |