| NPI | 1245848977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2020021111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-6922) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2020-07-20 |