| NPI | 1346529385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007877) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NC 4625) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2025-05-28 |