| NPI | 1609984061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2003020133) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-03542) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2022-06-23 |