| NPI | 1972590735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 007712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 10346) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2022-03-10 |