| NPI | 1336590439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016022646) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05336) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2016-06-29 |