| NPI | 1013437177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2017032698) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05692) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2020-06-16 |