| NPI | 1003407875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-07350) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT36654) |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2023-06-22 |