| NPI | 1336667690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: KY 003758) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: KY 003758) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2022-07-21 |