| NPI | 1821657586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213210) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018121) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2019-09-24 |