| NPI | 1043635501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 1858) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04736) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2019-06-27 |