| NPI | 1922969328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: KY 009507) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251N0400X Physical Therapist, Neurology | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2025-11-24 |
| Last Update Date | 2025-11-24 |