| NPI | 1609320654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27080) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2016027713) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2021-06-10 |