| NPI | 1891253001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT021483) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027513) |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: FL PT37811) | |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2025-01-03 |