| NPI | 1790533412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032307) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT021019) |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2025-10-21 |