| NPI | 1932581006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT015393) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1260286) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2025-03-13 |