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Individual
MALCOLM JAMES LICKERS
Active
Individual
MALCOLM JAMES LICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
2305202376
VA
Other
Enumeration date
10/05/2020
Last updated
10/05/2020
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