| NPI | 1821978388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-034364) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT021802) |
| Enumeration Date | 2025-09-05 |
| Last Update Date | 2025-09-05 |