| NPI | 1750008595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 3235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT019966) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2022-10-24 |