| NPI | 1407847262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: KY 002321) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 002321) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2017-05-31 |