| NPI | 1437601606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2020009139) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13645) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2022-06-21 |