| NPI | 1679051395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2018028506) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2023-04-24 |