| NPI | 1508526161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT-008432) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 008432) |
| 225100000X Physical Therapist (Licence: OH CP019062T) | |
| Enumeration Date | 2021-12-23 |
| Last Update Date | 2024-09-24 |