| NPI | 1598104341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2001018653) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-03087) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2013-06-14 |