| NPI | 1336552777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2014023065) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04859) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2017-03-28 |