| NPI | 1356919781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2023000918) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06763) |
| Enumeration Date | 2021-06-13 |
| Last Update Date | 2023-01-13 |