| NPI | 1992100945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT016095) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MT PTP-PT-LIC-7671) |
| Enumeration Date | 2014-11-01 |
| Last Update Date | 2019-09-24 |