| NPI | 1003993577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: KY PT000631) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT02527) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-04-13 |