| NPI | 1689825267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 002428) |
| Additional Taxonomies | 171W00000X Contractor (Licence: KY 9769024) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2014-01-31 |