| NPI | 1730336314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2008032777) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1103880) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2018-05-08 |