| NPI | 1942986005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16372-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020404) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2023-06-23 |