| NPI | 1841587300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008199) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT013179) |
| 225100000X Physical Therapist (Licence: IN 05010472A) | |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2021-07-30 |