| NPI | 1598437923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008964) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: KY 148448) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2023-11-21 |