| NPI | 1962724633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05004979A) |
| 225100000X Physical Therapist (Licence: OH PT005801) | |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2023-02-14 |