| NPI | 1407139405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2010036113) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04162) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2015-04-22 |