| NPI | 1558770669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2014026956) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2014025469) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2022-03-25 |