| NPI | 1346295664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT002833E) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 20572) |
| 225100000X Physical Therapist (Licence: KY 002980) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2013-06-17 |