| NPI | 1922831650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT021376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT44102) |
| 225100000X Physical Therapist (Licence: SC 13338) | |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2026-05-15 |