| NPI | 1750871331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2018024531) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05853) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2021-07-09 |