| NPI | 1366689242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005368) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KY PT-005368) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2016-05-24 |