| NPI | 1417263062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005729) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 002857) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2021-03-11 |