| NPI | 1265212690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: KY CP051966T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 15216) |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2026-01-07 |