| NPI | 1275583601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2002005834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1103297) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2016-07-11 |