| NPI | 1710317474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 108002) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-02814) |
| Enumeration Date | 2013-11-16 |
| Last Update Date | 2013-11-16 |