| NPI | 1821025248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1338368) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT6697) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2024-02-06 |