| NPI | 1033535158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY CP008809T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT 003295) |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2024-11-20 |