| NPI | 1003265356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016024378) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05394) |
| 225100000X Physical Therapist (Licence: AR PT 4261) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2017-02-09 |