| NPI | 1033662788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 006895) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OH CPO18924T) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2023-05-05 |