| NPI | 1619497997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007135) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY T16109) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2018-07-30 |