| NPI | 1063887818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005590) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY B12-232-542) |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2017-04-05 |