| NPI | 1679120315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 006736) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 006736) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2025-07-24 |