| NPI | 1083755953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019000114) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05563) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2025-01-29 |