| NPI | 1669614814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2010041904) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8419) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2022-07-21 |