| NPI | 1811446651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT016570) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070022650) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2018-10-23 |