| NPI | 1588156970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20329) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019016461) |
| 225100000X Physical Therapist (Licence: KS 11-05958) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2021-04-05 |