| NPI | 1962277491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: OH PT020784) |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2024-12-19 |