| NPI | 1053300277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 001533) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: KY 10011030054) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2017-02-27 |