| NPI | 1720638513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007827) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY TP2019108) |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2021-12-03 |