| NPI | 1770148090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019125) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013318A) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2021-04-26 |