| NPI | 1780105866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008234) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2017020306) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2021-09-17 |