| NPI | 1124337035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005660) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT005660) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2023-07-06 |