| NPI | 1568087658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2020018425) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06484) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2020-07-13 |