| NPI | 1487640769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251H1200X Physical Therapist, Hand (Licence: KY PT-004054) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 004054) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2018-10-30 |