| NPI | 1083269856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 14-03400) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KS 14-03400) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2019-08-07 |