| NPI | 1972295491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 232488) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020373) |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2025-01-22 |