| NPI | 1437631769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007551) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY TP2018113) |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2020-10-07 |