| NPI | 1023749546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008587) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY TP2022057) |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2022-08-04 |