| NPI | 1215470125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 006678) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 004165) |
| Enumeration Date | 2016-11-24 |
| Last Update Date | 2023-12-04 |