| NPI | 1790517647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY CP038651T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP033345T) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-12-16 |