| NPI | 1720033533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: KY PT001844) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT001844) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2023-03-22 |