| NPI | 1841624681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH 015235) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 40423) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2022-09-26 |