| NPI | 1598454969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2023017876) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04524) |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2023-06-07 |