| NPI | 1811269384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005906) |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: KY 005906) |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2024-06-21 |