| NPI | 1003807819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: KY 001746) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38134) |
| 225100000X Physical Therapist (Licence: KY 001746) | |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2025-12-02 |