| NPI | 1720425366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 098112) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2014008169) |
| 225100000X Physical Therapist (Licence: KS 11-04560) | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2025-01-14 |