| NPI | 1992427090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008690) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY T92022070) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2022-11-03 |