| NPI | 1699736454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT001318) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY AT076) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2023-04-13 |