| NPI | 1710610746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022032768) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05452) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2025-06-04 |