| NPI | 1326511247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2018043461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2197) |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2019-01-03 |