| NPI | 1093136046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25234) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1104384) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2023-09-20 |