| NPI | 1083827836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05178) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017070) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2023-01-30 |