| NPI | 1053745018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03527) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 20060138) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2023-02-10 |