| NPI | 1972023869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019001291) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1106335) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-09-21 |