| NPI | 1396252185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2017037109) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05772) |
| 225100000X Physical Therapist (Licence: VA 2305212685) | |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2022-09-20 |