| NPI | 1124433891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY CP014405T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10043) |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2025-01-03 |