| NPI | 1689056483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2015027170) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015017586) |
| 225100000X Physical Therapist (Licence: KS 1105534) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2021-03-04 |