| NPI | 1871503318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P10616) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT011406) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2023-07-27 |