| NPI | 1649898693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2023020721) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1106463) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2023-12-08 |