| NPI | 1245853118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2024037837) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS T-05243) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2024-10-24 |