| NPI | 1669040903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 115067) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1106738) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2022-09-14 |