| NPI | 1578978797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2014027053) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2014018751) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2025-01-20 |