| NPI | 1740892249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 6876) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: KY 006876) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2020-10-22 |