| NPI | 1699852442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2008002441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 4746-024) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-09-29 |