| NPI | 1477906170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016019662) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1105361) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2024-02-08 |