| NPI | 1760930960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019678) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 291904) |
| 225100000X Physical Therapist (Licence: AZ LPT-012963) | |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2022-05-12 |