| NPI | 1558531657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005263) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KY 005263) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2023-12-20 |