| NPI | 1962868950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT018948) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA.10259) |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2020-11-02 |