| NPI | 1295854222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS T-W0044-0) |
| 225100000X Physical Therapist (Licence: TX 1145704) | |
| 225100000X Physical Therapist (Licence: MO CP024673T) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2024-04-25 |