| NPI | 1336710730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008772) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37368) |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2023-05-24 |