| NPI | 1003872565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 226300000X Kinesiotherapist (Licence: VA 1114) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: VA 0715002119) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-05-12 |