| NPI | 1891104055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29566) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 018508) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2020-03-17 |