| NPI | 1447291075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 000996) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: KY 996) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2011-11-22 |