| NPI | 1093429573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-07099) |
| 225100000X Physical Therapist (Licence: MO 2022024207) | |
| 225100000X Physical Therapist (Licence: CA 303384) | |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2024-06-21 |