| NPI | 1750957288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10210) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PTO19124) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2023-03-06 |