| NPI | 1205498284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019029568) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06251) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2020-02-11 |