| NPI | 1285917666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT005831) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT021284) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2011-09-22 |