| NPI | 1023007002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251E1300X Physical Therapist Electrophysiology, Clinical (Licence: KY 002543) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: KY 002543) |
| 225100000X Physical Therapist (Licence: KY 002543) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2021-09-23 |