| NPI | 1265796791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019027814) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1106218) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2019-11-18 |