| NPI | 1750990941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019130) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT004208) |
| 225100000X Physical Therapist (Licence: PA PT027967) | |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2021-05-24 |