| NPI | 1578916136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016022080) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1105318) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |