| NPI | 1922682277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT019150) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2023-07-05 |