| NPI | 1740661362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT006611) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT003496) |
| 225100000X Physical Therapist (Licence: OH PT015332) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2019-05-08 |