| NPI | 1881187177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298383) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT017464) |
| 225100000X Physical Therapist (Licence: MD 27559) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2023-09-13 |