| NPI | 1801113717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH CP031036T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6091) |
| 225100000X Physical Therapist (Licence: NC 12319) | |
| 225100000X Physical Therapist (Licence: PA PT020060) | |
| 2251N0400X Physical Therapist, Neurology (Licence: OH CP031036T) | |
| Enumeration Date | 2010-05-01 |
| Last Update Date | 2024-06-03 |