| NPI | 1942817069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019029) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046341) |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2021-06-10 |