| NPI | 1851178578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP042132T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020717) |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2025-02-27 |