| NPI | 1043397508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: KY PT001261) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OH PT06940) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-04-09 |