| NPI | 1639783731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT-008139) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2020-11-09 |