| NPI | 1063872224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05069) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 078625) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2016-03-02 |