| NPI | 1285329011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2023016507) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: KS 11-07276) | |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-05-09 |