| NPI | 1811106305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 004514) |
| Additional Taxonomies | 2251E1200X Physical Therapist Ergonomics (Licence: KY 004514) |
| 2251S0007X Physical Therapist Sports (Licence: KY 004514) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: KY 004514) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2022-07-21 |