| NPI | 1568061208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2020034759) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06564) |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2020-10-23 |