| NPI | 1477108710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019043529) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06394) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2020-03-31 |