| NPI | 1295807592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 001366) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 001366) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2017-06-15 |