| NPI | 1912599408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.008467RX) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT018530) |
| Enumeration Date | 2021-02-06 |
| Last Update Date | 2024-04-01 |