| NPI | 1760052484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2021021318) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06841) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-11-04 |