| NPI | 1861065013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1346973) |
| 225100000X Physical Therapist (Licence: OH PT019373) | |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2024-10-03 |