| NPI | 1043651771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2013023642) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04610) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2013-07-10 |