| NPI | 1851844054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016020976) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05366) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |