| NPI | 1235491754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT006022) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27344) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2013-03-07 |