| NPI | 1831276369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019658) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY PTA A02112) |
| 225200000X Physical Therapy Assistant (Licence: OH PTA 05947) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-02-14 |