| NPI | 1396713129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: KY 005058) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 008414) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2022-01-04 |