| NPI | 1942971072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT008512) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37867) |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2022-06-23 |