| NPI | 1730229691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 014140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 19459) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-11-21 |