| NPI | 1477039402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2018025002) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05883) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2019-12-02 |