| NPI | 1750704052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007893) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT016109) |
| 225100000X Physical Therapist (Licence: DC PT871714) | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2021-10-28 |