| NPI | 1801387766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: OH PT017041) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT017041) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2025-05-12 |