| NPI | 1023018827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-02336) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2001018689) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2008-01-31 |