| NPI | 1720069818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 00147) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-00260) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2014-03-31 |