| NPI | 1558319004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 110205) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1102396) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2020-03-11 |