| NPI | 1437508793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016023453) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05424) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2018-08-30 |