| NPI | 1790915015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 37767) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT 12531) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2025-03-19 |