| NPI | 1184208563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008374) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY TP2021023) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2021-09-03 |