| NPI | 1366072688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019045304) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1106344) |
| Enumeration Date | 2020-01-26 |
| Last Update Date | 2020-01-26 |