| NPI | 1740986678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT020260) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA011801) |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2023-02-08 |