| NPI | 1447201819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: KY ABPTS #4356) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY KY001459) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2014-03-13 |