| NPI | 1265744254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 003580) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 3580) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2012-12-20 |