| NPI | 1437843778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT009032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT031272) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2025-11-05 |