| NPI | 1760974570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT020587) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10734) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2025-01-25 |