| NPI | 1780084012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT015147) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT008804) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2020-05-08 |