| NPI | 1851023915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: OH PT019869) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2024-11-05 |