| NPI | 1184192577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16902) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO CP026005T) |
| 225100000X Physical Therapist (Licence: IA 120629) | |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2024-07-25 |