| NPI | 1558882878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 26873) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05757) |
| 225100000X Physical Therapist (Licence: MO 2017029236) | |
| 225100000X Physical Therapist (Licence: CO 0018840) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2023-08-29 |