| NPI | 1114385770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT0093440) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: SC 7985) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2025-07-09 |