| NPI | 1558924928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY CP000816T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 18542) |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2023-04-24 |