| NPI | 1558902510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC CP029705T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1106327) |
| 225100000X Physical Therapist (Licence: MO 2019030127) | |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2024-04-15 |